Provider Demographics
NPI:1518026699
Name:UNIVERSITY PHYSICIANS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS, INC.
Other - Org Name:CU MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-848-2171
Mailing Address - Street 1:1635 URSULA ST
Mailing Address - Street 2:BOX 6510, MS F-722
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7402
Mailing Address - Country:US
Mailing Address - Phone:720-848-2171
Mailing Address - Fax:720-848-2157
Practice Address - Street 1:1635 URSULA ST
Practice Address - Street 2:BOX 6510, MS F-722
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7402
Practice Address - Country:US
Practice Address - Phone:720-848-2171
Practice Address - Fax:720-848-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15797207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COO115797Medicaid
COD28159Medicare UPIN
COO115797Medicaid